step1
Forum Newbie
Topics: 5
Posts: 38
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00:52:57 step1 enters this room
00:52:58 » [step1] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite.
00:54:36 [step1] hi rene..you are from which time zone?
00:54:37 [Renegade] Hi, step1
00:54:44 [Renegade] GMT
00:54:51 [Renegade] So yes, it's good evening
00:55:06 [step1] what time is there...?
00:55:11 [step1] ok
00:55:31 [step1] what you want to discuss today?
00:56:12 [Renegade] Follow schedule... cardiovascular, respiratory and GI
00:56:44 [step1] ok
00:58:48 [step1] ready to start.or we can wait 5 more min.?
01:00:43 [Renegade] hiwa and rjay sais they'd be here
01:01:00 [step1] ok
01:03:54 [step1] we can start with heart sounds and murmurs....
01:05:39 doctorjha enters this room
01:05:58 [Renegade] hi, jha
01:06:17 [step1] hi doc
01:06:20 [doctorjha] hey, seems u guys r on for step 2?
01:06:50 [step1] its for step1
01:07:06 [doctorjha] heart sounds and murmur..wow!
01:07:44 [doctorjha] anyway, I would like to just be a part..u guys carry on! I am done with step 1 though
01:07:50 [step1] you are here for step2?already took step1?
01:07:57 [step1] oh nice
01:08:16 [step1] Goljan's path is imp. for step2 too
01:08:50 [doctorjha] yeah, I just saw some scary messages on forum that they r asking too much of step 1 path
01:09:21 [step1] rt
01:09:45 [step1] its mainly clinical path
01:11:43 [step1] 72 yrs old man presents with sudden onset of flank pain .He is hypotensive,pulsatile mass is palpable in the abdomen...Dx?
01:12:02 [step1] i mean patho involved here?
01:12:03 [Renegade] rupture of aorta aneurysm
01:12:32 [step1] ruptured abd. aortic aneurysm
01:13:49 [step1] 65 yrs old man on 5 th day of hospitalization for an ac. ant. MI has recurrence of chest pain and inc. in both CK-MB and troponin.....Dx?
01:14:59 [Renegade] Another MI... ecg to find out where exactly.
01:15:40 [step1] ya...CK-MB suggests reinfarction
01:16:44 [Renegade] Especially troponin
01:16:46 [step1] 70yrs old man with dimished pulse and a h/o angina and syncope with exercise has an ejection murmur radiating into the carotid art....Dx?
01:18:01 [step1] » [Renegade] rt
01:18:58 [step1] ?
01:19:09 [Renegade] classify the murmur according to sys/diast prevalence
01:20:18 [Renegade] So by ejection you mean...?
01:20:53 [step1] ok.my Q's ans is aortic stenosis
01:22:10 [step1] » [Renegade] how will you classify murmurs according to sys/dias. prevalence?
01:22:46 [step1] continuous...occurs through syst. and diastole
01:23:48 [step1] innocent...d/t pulm. art blood flow in systole
01:24:25 [step1] stenosis murmurs: valve opening in systole: AV/PV
01:24:39 [step1] and in diastole: MV/TV
01:25:47 [doctorjha] wait guys....systolic murmurs are MR and AS..
01:26:08 [doctorjha] Diastolic murmurs are MS and AR...Ur definition is true though
01:26:12 hiwa enters this room
01:26:47 [step1] hi hiwa
01:27:06 [hiwa] hi everybody
01:27:18 [Renegade] ah, there u are. welcome
01:27:20 [doctorjha] so, MR/TR, AS/PS are systolic ones...
01:27:32 [step1] regurgitation murmurs-problem with closing valves
01:27:35 [doctorjha] AR/PR, MS/TS are diastolic ones
01:27:50 [step1] in syst: MV/TV
01:28:13 [step1] in diastole:AV/PV
01:28:50 [step1] oh.i am classifying according to rene's Qs...
01:29:22 [step1] prob. during systole or in diastole
01:29:33 [step1] » [doctorjha] .ya u r right
01:29:58 [Renegade] ah, there. windows are shut now.
01:30:14 [doctorjha] yeah, ur classification is perfect....but, its about the blood flow and not the valves..
01:30:24 [Renegade] So aortic stenosis would be mmidsystolic, then
01:30:40 [doctorjha] nope, AS will be ejection systolic
01:30:41 dishal enters this room
01:30:42 [step1] rt
01:30:52 [step1] hi dishal
01:31:00 [dishal] hi
01:31:15 [doctorjha] MR or VSD will be pansystolic
01:32:35 [doctorjha] in systole, blood is pushed from the ventricle....problems may be in AS, MR or VSD
01:32:40 [step1] » [doctorjha] and TR too..pansystolic
01:33:01 [doctorjha] yeah, MR/TR go together..
01:33:10 [doctorjha] AS/PS go together
01:33:11 [step1] rt
01:33:30 [step1] AS,PS,ASD...systolic ejection
01:33:48 [step1] AR,PR,MS...diastolic
01:34:07 [doctorjha] yup
01:34:49 [doctorjha] dont bring ASD in between though..it has nothing to do ventricles..no murmur
01:34:57 [step1] ok.what happens during Valsalva maneuver?
01:35:13 [step1] physiologic effects?
01:35:22 [doctorjha] u get a combo of ejection systolic and MDM D/T different reason
01:35:46 [doctorjha] valsalva manoeuvre...thats a great q
01:36:11 [doctorjha] lemme think a bit...it aggravates a few murmur and accentuates a few
01:36:29 [step1] ya
01:38:11 [doctorjha] well, valsalva basically would relief in systole....and thus would decrease MR/VSD
01:38:52 [step1] increase intensity of systolic murmur in hypertrophic cardiomyopathy,decrease intensity of ejection murmur of AS : less blood ejected through stenotic valve
01:39:10 [doctorjha] But, i remembered it just like that..it only increases murmur in case of HOCM and decreases elsewhere
01:40:01 [step1] HOCM?
01:40:13 [step1] RT
01:40:55 [step1] also moves systolic click/murmur closer to S1 in mitral valve prolapse
01:40:56 [doctorjha] hi hiwa..i think u r for step 2?
01:41:31 [doctorjha] thanks...MVP..wow! its a big hit on boards..
01:41:58 [doctorjha] do u know the MC cause of MR in US?
01:42:06 [step1] Cause of sudden death in hypertrophic cardiomyopathy?
01:42:54 [doctorjha] i dunno the cause...its a diastolic dysfunction..thats what i know
01:43:24 [Renegade] Possible ventribular arrytmia...
01:43:50 [Renegade] ...common in certain athletes.
01:43:52 [step1] » [doctorjha] MVP
01:44:14 [step1] MVP is the MC of MR in US
01:44:16 [doctorjha] true
01:45:49 [step1] ya..conduction disturbances are responsible for sudden death
01:45:53 [hiwa] iam back
01:46:07 [doctorjha] keep firing...i m here...hi hiwa!
01:46:21 [step1] there is dec. diastolic filling b/c of muscle thickening
01:47:00 [hiwa] true and outlet obstuction
01:47:15 [hiwa] hi doc
01:47:16 [step1] Sudden Death in Marfan syndrome?
01:47:32 [doctorjha] and best part is NEVER GIVE Digoxin, diuretics and dilators to HOCM Pts.
01:47:34 [Renegade] And fibrosis due to lack of oxygen in myocardium
01:47:39 [hiwa] conduction defect
01:47:54 [Renegade] ...with frequent creation of reentry circuits.
01:48:12 [hiwa] true
01:48:20 [step1] » [hiwa] rt..
01:48:28 [Renegade] sudden death in MS? Aortic rupture...
01:49:19 [doctorjha] re-entrant arrythmia is MC cause of VF and VF is MC cause of sudden death overall
01:49:41 [doctorjha] Marfan's will have aortic rupture..that makes sense
01:50:01 [Renegade] (...especially in athletes with huge myocardium.)
01:50:15 [step1] ya..bec of production of weak elastic tissue
01:50:49 [doctorjha] fibrillin gene a big hit on boards
01:51:24 [Renegade] fibrillin 1, don't mistake it for fib 2
01:51:32 [step1] CV abnormalities are always there...dilatation of ascending aorta may progress to aortic dissection/AR
01:53:12 [Renegade] Infectious causes for myocarditis?
01:53:19 [step1] what is Phlebothrombosis?
01:53:29 bm enters this room
01:53:35 [doctorjha] Coxsackie B
01:53:54 [doctorjha] and phlebothrobosis is venous thrombosis..is it different?
01:53:57 [hiwa] chagas
01:54:16 [hiwa] TB
01:54:39 [step1] » [Renegade] coxsackievirus,T. cruzi
01:54:44 [doctorjha] Chagas in a south american, TB in an asian
01:54:53 [Renegade] Actually, hiwa, TB isn't a main cause.
01:54:59 [doctorjha] sometimes i remember the regions..
01:55:07 [hiwa] diphtheria
01:55:14 [Renegade] btw, and in an African?
01:55:33 [step1] » [doctorjha] thrombosis of vein without inflammation
01:55:59 [Renegade] ...plenty of parrots there, no?
01:56:01 [step1] MCC is stasis of blood
01:56:07 [hiwa] yes tb mainly pericarditis
01:56:16 [step1] hypercoagulability
01:56:17 [bm] what are the topics covered today
01:56:37 [Renegade] We're in cardiovascular... next lungs and gi
01:56:45 [bm] ok thanks
01:56:57 [step1] we started with cvs..will cover RS,GIT etc
01:57:31 [Renegade] I was referring to C. psittaci
01:57:41 [step1] sign of deep vein thrombosis?
01:57:57 [hiwa] redness
01:58:06 [Renegade] Homan sign
01:58:09 [bm] dyspnea
01:58:13 [doctorjha] Homan's sign
01:58:15 [hiwa] swelling
01:58:16 [Renegade] in IM, of course
01:58:18 [bm] oh sorry
01:58:20 [doctorjha] i mean calf pain
01:58:21 [bm] that's symptom
01:58:29 [step1] » [hiwa] statis dermatitis
01:58:37 [Renegade] Redness and swelling may not be obvious, since it's deep
01:58:49 [hiwa] ok
01:59:02 [doctorjha] MC Site of DVT..
01:59:10 [step1] orange discoloration around the ankle c/by rupture of penetrating branches
01:59:12 [doctorjha] Ileofemoral vein...
01:59:39 [step1] orange disc. is b/c of hemosiderin
02:00:25 [step1] » [doctorjha] deep vein of the calf
02:00:30 [hiwa] they r sighns of chronic venous insufficiency u talking about, that DVT may be one of the cuses
02:00:31 [Renegade] Yes, after a week
02:02:45 [Renegade] Most frequent heart tumor and syndrome frequently associated?...
02:03:10 [bm] i don't think there is any specific sign for dvt, but i do agree that there are symptoms such as calf pain, and dyspnea especially in a person immobilized for awhile
02:03:31 [bm] myxoma
02:03:50 [step1] post-surgical,bedridden pt. develops sudden shortness of breath..Dx?
02:03:54 [hiwa] carcinoid
02:04:06 [hiwa] pe
02:04:22 [bm] pe secondary to dvt
02:04:56 [Renegade] syndrome was Carney's
02:04:59 [step1] rt..and Dx can be confirmed by Ventilation /Perfusion scan
02:05:12 [hiwa] pt with bilateral tibial fructure, with dyspnoea chest pain and confusion , DX?
02:05:25 [doctorjha] fat embolism
02:05:29 [bm] same
02:05:41 [hiwa] true
02:06:08 [Renegade] ...confusion? Embolism to brain..?
02:06:15 [step1] and develops after 1-3 days of fracture of long bone
02:06:21 [doctorjha] add purpura to add flavor to fat embolism.
02:07:12 [hiwa] No, it is physiological I dont know the mechanism
02:07:14 [step1] » [Renegade] ya...release of fat globules from marrow may occlude vess in lungs and brain
02:07:55 [bm] maybe the confusion is due to dec oxygen to brain?
02:08:18 [doctorjha] well, just a point i would like to make...atheromatous emboli and fat emboli both come with purpura...but..
02:08:25 [step1] rt
02:08:47 [doctorjha] cholesterol emboli r in lower part of body and fat emboli ones r in upper part..
02:09:03 [step1] ok
02:09:12 [Renegade] italic
02:09:16 [Renegade] meh
02:09:25 [Renegade] Main causes of cor pulmonale?
02:09:47 [bm] right heart failure?
02:09:56 [doctorjha] COPD...
02:10:14 [hiwa] might be primary pulmonary HTN
02:10:26 [step1]» [Renegade] pulm. parenchymal dis
02:10:44 [step1] like..COPD,TB,pneumoconiosis
02:11:14 [step1] ALSO..VASCULITIS
02:11:24 [Renegade] And a hereditary one?
02:11:26 [hiwa] asthma
02:11:34 [step1] or multiple emboli
02:11:44 [hiwa] bronchiectesis
02:11:46 [doctorjha] Again i will fire MC cause of RHF..
02:12:27 [Renegade] Cystic fibrosis
02:13:34 [hiwa] Any thing leads to hypoxia because of the disease of the lung, vessels or thorax(Kyphoscoliosis)
02:14:26 [dishal] myocarditis
02:14:29 [Renegade] Which reminds me, obesity as well...
02:14:35 [doctorjha] MC of Right heart failure is left ventricular failure and stress is DONT answer cor pulmonale
02:15:10 [step1] Positive Adson's test...Dx?
02:15:18 [bm] yup you're right
02:15:41 [doctorjha] never heard of adson's test..
02:16:22 [Renegade] Many causes of compression of subclavian artery...
02:16:26 [bm] what is the test for
02:16:49 [step1] Adson's test: pulse disappeared when arm is outstretched and pt. looks to the sitde of the outstretched arm.....Dx is Thoracic outlet syndrome( common in wt lifters)
02:17:07 [Renegade] A professor said that if you suspect it, you have to perform eco anyway, so...
02:17:41 [bm] thanks step1
02:17:53 [step1] u r welcome
02:18:01 [doctorjha] thanks guyz
02:18:30 [doctorjha] all of u will score 99..
02:18:48 [hiwa] Y u need echo
02:19:04 [step1] An IV drug abuser with chr. hepatitis who has inflammed mass on lower extr. and hematuria.....Dx?
02:19:14 [bm] doctorjha » thanks for th boost
02:19:29 [doctorjha] i too would like to hear why an echo in thoracic outlet syndrome?
02:19:44 [bm] ?
02:19:55 [step1]» [doctorjha] thanks doc..and really appreciate your contribution in chat
02:20:41 [step1]» [Renegade] ya..why eco in thoracic outlet syn?
02:20:51 [doctorjha] for the hepatitis q, i was thinking of cryoglobulinemia
02:21:38 [bm] i'm curious- is it possible not to have jaundice despite infection with hep virus?
02:21:45 [doctorjha] hepatorenal syndrome..whats the answer?
02:21:50 [Renegade] Apparently, the interscalene triangle may not be the only cause of compression, and other causes should be searched for... prolly tumors, I guess.
02:21:50 [step1]» [doctorjha] pt. has polyarteritis nodosa...
02:22:05 [step1] has asso. with HBsAg
02:22:25 [hiwa] thanx Rene
02:22:28 [doctorjha] oh yes...u will ace the test..i got PAN reasoning...great q
02:23:15 [step1]» [Renegade] thanks
02:23:25 [doctorjha] Hep. C pt has cryoglobulinemia...
02:23:46 [hiwa] yes and PANCA is positive
02:23:52 [step1] MCC of saddle nose deformity in US?
02:23:59 [doctorjha] kidney + liver - hepatorenal syndrome, PAN....
02:24:24 [hiwa] cong syphlis
02:24:28 [doctorjha] Kidney + lung = Goodpasture's, Wegener's (+sinusitis)
02:24:46 [step1] Wegener's granulomatosis
02:25:08 [hiwa] yep
02:25:14 [step1] bec. of involvement of upper resp. tract
02:25:47 [doctorjha] C-ANCA this time
02:25:59 [step1] MC vasculitis in children?
02:26:15 [bm] step1» that's interesting. thanks for the info. for a moment there, i was thinking of syphilis for saddle nose
02:26:30 [step1]» [doctorjha] rt
02:26:37 [hiwa] HSP
02:26:49 [step1]» [hiwa] rt
02:27:04 [step1] c/p of HSP?
02:27:09 [doctorjha] wegener's is mc
02:27:52 [doctorjha] Oh no..HSP IS RIGHT..
02:28:07 [step1] c/p of HSP: palpable purpura of buttocks and lower extr.
02:28:38 [hiwa] what about IgA nephropathy
02:29:14 [doctorjha] IgA nephropathy is MC cause of adult nephropathy
02:29:23 [bm] got to go. nice chatting with you guys
02:29:50 [step1] thanks for joining the chat bm....bye
02:30:10 [hiwa] ok
02:30:20 [doctorjha] Berger's buerger's...and 2 buerger's...confuses a lot..
02:30:28 [step1] primary mech. in essential hypertension?
02:30:31 bm exits from this room
02:30:50 [hiwa] acute abdomen main cf of hsp
02:31:24 [step1] Berger's dis( IgA nephropathy)
02:31:56 [step1] Buerger's dis ( thromboangitis obliterans)
02:32:06 [step1] ter to remeber other names too
02:33:23 [step1] reduced renal sodium excretion is the pri. mech. of essential hypertension
02:34:01 [dishal] seen in african americans
02:34:03 [step1] Inc. plasma vol. suppresses renin release from Juxtaglomerular apparatus
02:34:43 [step1]» [dishal] rt
02:34:57 [step1] also elderly
02:36:03 [dishal] elderly low renin ht have
02:36:22 [dishal] due to increase plasma volume
02:36:35 [dishal] from sodium retension
02:36:51 [step1] pain is releived when sitting up and leaning forward and inc with respiration.....Dx?
02:37:13 [step1] inc with inspiration?
02:37:14 [hiwa] pericardirtis
02:37:15 [Renegade] pericarditis
02:37:20 [step1] rt
02:37:31 [hiwa] causes ?
02:37:37 [step1] Beck's Triad?
02:37:38 [Renegade] Sorry, anyone knows if those 100 pages of Goljan are available in a doc, as in, not scanned?
02:38:30 [dishal] true
02:38:33 [hiwa] it is a sign of restrictive pericarditis or cardiac tamponad
02:38:42 [step1]» [hiwa] coxsackievirus
02:38:43 [Renegade] mufled heart sounds... decrease of BP in inspiration...
02:39:08 [Renegade] and the last is either dispnea or increased HF
02:39:08 [hiwa] bacterial?
02:39:31 [step1]» [Renegade] for 100 pgs.i think i saw somewhere from where u can download.i will let u know
02:39:47 [dishal] mcc viral pericardititis coxszckie
02:40:11 [step1]» [Renegade] rt
02:40:16 [dishal] most common d in sle
02:40:22 [hiwa] malignancy , secondaries
02:40:49 [hiwa] Uraemia
02:41:02 [Renegade] (No, I posted in that thread... I got them scanned, but it's 38 MBs or something... huge. )
02:41:38 [step1] ok
02:42:18 [Renegade] (I think I'll suggest there for ppl to make it into doc... 10 ppl typing 10 pages each, wouldn't be long. I'd type 20 myself...)
02:42:46 [hiwa] try this site http://www.tormusayya-online.com/Goljan%20100%20hy.pdf
02:43:40 [hiwa] so what is becks triad?
02:44:28 [dishal] what kind of pericarditisis seen in tb,neck vein distension on inspiration
02:44:37 [dishal] hypotension
02:44:59 [dishal] andmuffled heart sound
02:45:05 [step1]» [hiwa] neck vein distension+hypotension+muffled heart sound
02:45:47 [step1] this is Beck's Triad...signs of pericardial effusion
02:45:50 [Renegade] That is scanned version, hiwa. Beck's triad isn't what it used to be, however... hypotension, decreasen jug. v. pressure, and the muffled heart sounds I meantioned.
02:46:49 [Renegade] Compared with dispnea, decreased hf and paradoxic pulse... :-/
02:47:19 [Renegade] I usually remember these 3 for pericardial effusion.
02:48:04 [hiwa] and we have kussmauls breathing as well
02:48:16 [step1] Newborn's mother complains that her baby turns blue during breast feeding and pinken up when she cries?...Dx?
02:49:15 [hiwa] oesophageal atresia
02:49:23 [Renegade] some upper airway obstruction... babies don't realize they can breathe through their mouth until they're like 6 months.
02:49:43 [step1] Dx is Choanal atresia : uni. or bilateral bony septum between nose and the pharynx prevents NB from breathing through nose
02:50:24 [step1] MC pathogen for sinusitis?
02:50:34 [hiwa] good point
02:51:10 PsychDr2B enters this room
02:51:16 [Renegade] pneumococci?
02:51:45 [step1]» [Renegade] rt
02:51:51 [PsychDr2B] hello, i'm going to read earlier to catch up
02:53:06 [step1] pt. with h/o smoking and asbestos exposure presents with persistent hoarseness,palpable cervical L.N.....Dx?
02:53:14 [step1]» [PsychDr2B] hi
02:54:07 [hiwa] streptococcus bronchogenic carcinoma
02:54:52 [step1] Laryngeal ca
02:55:41 [hiwa] is there relation bet asbestos and Lary. ca.
02:56:14 [dishal] yes it is one of the cause
02:56:18 [step1] post-op pt. presents with restrictive breathing and fever...MC Dx?
02:57:14 [step1]» [hiwa] yes...it is common risk factor for lary. ca
02:57:17 [hiwa] chest infection
02:57:36 [hiwa] thanx step1
02:58:19 [step1] Resorption atelectasis..d/t mucous plug blocking in the terminal bronchioles.
02:58:21 [dishal] atelactasis
02:58:35 [step1]» [dishal] rt
02:58:43 [hiwa] what about fever ?
02:59:11 [dishal] fever in first 12 24 hrs post op is atelectasis
02:59:44 [step1] during this time pt.'s breathing may be restricted bec. of pain and fear of coughing.
03:00:15 [dishal] rt
03:00:20 [Renegade] Hmm, what would you expect to differ in pulmonary infiltrates in 2 immunocomp. pts, if one has a virus and the other a fungus?
03:02:45 [hiwa] by alveolar lavage
03:03:35 [Renegade] I mean the differences in infiltrates
03:04:23 [step1] ??
03:04:27 [hiwa] dont know
03:04:49 [Renegade] viral is always diffuse
03:05:11 [Renegade] fungal is usually focal, rarely diffuse.
03:05:43 [Renegade] ...as with most gram - rods.
03:06:02 [hiwa] also might calcify and cavitate cause it says similar to TB
03:06:19 [step1] Newborn with maternal diabetes presents with RDS....cause?
03:06:59 [hiwa] the answer is already there
03:07:02 [PsychDr2B] hyperglycemia
03:07:38 [PsychDr2B] leads to increase in fetal release of insulin
03:07:49 [hiwa] or big baby delivered by CS
03:07:54 [PsychDr2B] thereby inhibiting surfactant synthesis
03:08:13 [step1] fetal hyperglycemia incr. insulin release,which inhibits surfactant synthesis
03:08:23 [PsychDr2B] yes
03:08:32 [step1] rt
03:08:40 [PsychDr2B] lol
03:08:53 [Renegade] Other main effect for insulin in newborn is?...
03:10:14 [step1] what can u give in premature infants to incr surfactant synthesis?
03:10:45 [PsychDr2B] oygen
03:10:50 [dishal] whdelivery of surfactant peep
03:10:53 [hiwa] steroids
03:10:53 [Renegade] Cardyomeg.
03:11:18 [step1]» [PsychDr2B] glucocorticoids
03:11:57 [PsychDr2B] yes, my computer is freezing I'll be back
03:11:58 doctorjha enters this room
03:12:02 PsychDr2B exits from this room
03:12:16 [doctorjha] fever third day post-op is UTI, Pneumonia
03:12:20 PsychDr2B enters this room
03:12:27 [doctorjha] 5th day post-op is thrombophlebitis
03:12:35 [step1] can give to premature NB's mother to incr. fetal surfactant synthesis
03:12:50 [doctorjha] 7th day is wound infection...10-15 day is deep abscess..
03:13:03 [doctorjha] sometimes timing on q does a lot of tricks
03:13:43 [doctorjha] steroid for increasing surfactant
03:14:11 [hiwa] given to the mother
03:14:14 [step1] rt
03:14:21 [doctorjha] but point is administer steroids 48 hours before delivery, else give exogenous surfactant
03:14:48 [step1] MC aspiration site in Lung?
03:15:04 [step1]» [doctorjha] YES
03:15:06 [doctorjha] upper part of lower lobe
03:15:16 [doctorjha] right lung
03:15:31 [hiwa] inwhat position
03:15:45 [step1] sup. seg. of rt. lower lobe
03:15:46 [doctorjha] posterior
03:16:17 [step1] it also depends on position of pt.
03:17:05 [step1] standing or sitting position: posterobasal seg of rt lower lobe
03:17:05 [hiwa] is the one u mentioned in sitting or lying
03:17:08 [doctorjha] usually u will find an alcoholic pt with cough
03:17:16 [hiwa] ok
03:17:24 [dishal] sudden onset pleuritic chest pain scuba diver colapsed lung
03:17:33 [dishal] diagnosis
03:17:36 [step1] in supine position: sup. seg. of rt lower lobe
03:18:05 [step1] guys my comp. became v. slow..i am missing Qs
03:18:09 [doctorjha] thats caisson's disease
03:18:27 [step1] agree
03:18:34 [dishal] sorry step1
03:19:08 [dishal] spontaneous pneumothorax
03:19:16 [hiwa] pneumoth
03:19:23 [step1]» [dishal] its ok..now looks fine
03:19:50 [doctorjha] yes u r rite....all scuba divers dont have caisson's..case should have said bone pains etc. for caissons
03:20:21 [dishal] don,t get carried with scuba
03:20:39 [step1] Can ozone( O3) cause Asthama?
03:20:49 [doctorjha] great insight..dishal :-) thanks
03:21:06 [dishal] you are welcome
03:21:47 [doctorjha] yes ozone can cause asthma, aspirin too..
03:22:09 [hiwa] what is the relation
03:22:37 [step1] O3 derives from interaction of O2 with nitrogen and sulfur oxides and hydrocarbons.....forms free radicals in airways.......inflammation and irritation and may precipitate Asthama
03:23:02 [doctorjha] inhale ozone and get bronchoconstriction....aspirin hypersensitivity+ nasal polyps and asthma make a triad
03:23:07 [step1] bec. of free radical damage
03:23:22 [dishal] rt
03:23:26 [hiwa] thanx
03:24:13 [step1] why cigarette smoking is MCC for emphysema?
03:24:32 [doctorjha] it causes alpha-1 antitrypsin def
03:25:57 [step1] C. smoking is chemotactic to neutrophils and macrophages that contain elastase.
03:26:27 [dishal] seen in panacinar emp
03:26:42 [step1]» [doctorjha] rt...free radicals in smoke inactivate alpha-1 antitrypsin
03:26:46 [step1]» [doctorjha] rt...free radicals in smoke inactivate alpha-1 antitrypsin
03:27:05 [step1] sorry for double hit
03:27:13 [Renegade] Mineral most commonly affected in lung paraneoplasic syndromes
03:27:32 [doctorjha] potassium
03:27:49 [Renegade] nop...
03:27:57 [hiwa] ca
03:28:04 [dishal] ca
03:28:09 [Renegade] that's it...
03:28:49 [Renegade] parathormone and prostandin E are frequently made by tumor cells
03:28:53 [doctorjha] well, i thought of SIADH and u bring hypercalcemia...Ca is more common i suppose..thanks
03:29:14 [step1] ok
03:29:38 [doctorjha] its not PTH but its PTHrP though
03:30:40 [step1] mucous-secreting pancreatic and colorectal ca....which P. syndrome?
03:32:34 [step1] non-bacterial thrombotic endocarditis
03:33:16 [dishal] lost connection
03:33:45 [step1] Projectile vomitting of non-bile stained fluid 2-4 wks after birth...Dx?
03:34:04 [dishal] pyloric stenosis
03:34:04 [doctorjha] do u mean Ca Pancreas and colorectal ca r associated with NBTE just like SLE...
03:34:33 Anil_Kumar980 enters this room
03:34:44 [step1]»[dishal] rt
03:34:54 [step1] hi Anil
03:35:12 [Renegade] hi there
03:35:21 [step1]»[doctorjha] yes
03:35:24 [hiwa] hi anil
03:35:33 [dishal] hi
03:35:43 [Anil_Kumar980] HELLO
03:36:04 [Anil_Kumar980] how do you do guys
03:36:05 [doctorjha] hey anil, i read ur post..congrats for 99 in step 1...hope u r all set for step 2 now
03:36:30 [step1]»[Anil_Kumar980] congrats
03:36:35 [Anil_Kumar980] Thank you doctor rjha.I am prep for it
03:36:44 [Anil_Kumar980] Thanks step 1
03:37:23 [Anil_Kumar980] are any of you guys givin step 2?
03:37:40 [doctorjha] keep the qs flowing....yeah, i m taking step 2..
03:38:14 [step1]»[Anil_Kumar980] need your contribution here
03:38:22 [Anil_Kumar980] sure
03:38:27 [Anil_Kumar980] can I help
03:38:36 [Anil_Kumar980] how can I help
03:38:46 Ahab enters this room
03:38:50 [PsychDr2B] have we switched to GI already?
03:38:56 [doctorjha] fire a q..
03:38:58 [dishal] bye guys got to go thanks for the chat
03:39:05 [PsychDr2B] following Goljan
03:39:20 [PsychDr2B] More qs Step1
03:39:35 [hiwa] Marantic endocarditis and thrombophlibitis migrans both caused by ca pancrease and may manifest as endocarditis
03:39:53 [step1] if pt. presents with non-tender mass in lt. supraclavicular area with epigastric prob. and weakness...first Dx?
03:40:11 [Ahab] gastric ca
03:40:13 [doctorjha] pancreas ca
03:40:20 [hiwa] ca stomach
03:40:21 [step1]»[dishal] bye .thanks
03:40:25 [Ahab] virchows node
03:40:33 [Renegade] stomach ca
03:40:34 [PsychDr2B] gatrci ca
03:40:35 [step1] metastatic adenoca
03:40:39 [Anil_Kumar980] Gastric Ca I guess
03:40:56 [Renegade] actually, peristomach ca...
03:41:06 [hiwa] the sign callled ?
03:41:25 [Anil_Kumar980] Panc cancer raely presents with a mass n usually presents with Jaundice and wasting
03:41:39 [Ahab] some back pain also
03:41:41 [PsychDr2B] is that a Virchow's node
03:41:44 [Anil_Kumar980] troussieu sign?
03:41:58 [Anil_Kumar980] troisier sign
03:42:08 [doctorjha] well, i heard incidence of gastric ca have reduced over decades and u can get virchow's in ca pancreas too
03:42:34 [Ahab] havent heard of pancreatic ca presenting with it before
03:42:37 [step1] Best invasive test for diarrhea?
03:42:39 [Ahab] source?
03:42:39 [Anil_Kumar980] yep but a mass is late in panc ca
03:42:58 [doctorjha] well, then surely i m wrong
03:43:09 [hiwa]»[step1] jejunal biopsy
03:43:17 [PsychDr2B] positive stool for fecal leukocytes
03:43:20 [Ahab] not saying you are wrong, just I have never heard of it before
03:43:49 [step1] fecal smear for leucocytes ositive stool culture,ova and parasite
03:43:52 [Anil_Kumar980] If its an invasive test may be its a biopsy?
03:43:55 [step1]»[PsychDr2B] rt
03:44:06 [Ahab] how is that invasive
03:44:31 [step1] pathogens invade enterocytes
03:44:45 [Anil_Kumar980] Colonoscopy and Biopsy is invasive I thought
03:44:50 [hiwa] tshigella
03:44:50 [step1] diarrhea with bld. and leucocytes
03:45:16 [hiwa] salmonella
03:45:17 [doctorjha] best initial test should be stool test and best invasive test should be colonoscopy and biopsy...
03:45:28 [Anil_Kumar980] oh you meant best est for invasive diarr?
03:45:37 [step1]»[Anil_Kumar980] sorry.i must write besr screening test for invasive diarrhea...typing error
03:46:03 [Anil_Kumar980] okay then its stool for bld and leuco
03:46:31 [step1] rt
03:47:04 [Ahab] when do you tx salmonella?
03:47:17 [step1] pt. shows lactose intolerance.....type of diarrhea?
03:47:28 [Anil_Kumar980] osmotic
03:47:29 [Ahab] osmotic
03:47:37 [step1]»[Ahab] rt
03:47:45 [step1] screening test ?
03:48:00 [PsychDr2B] brat test for H2
03:48:04 [PsychDr2B] breath
03:48:06 [PsychDr2B] not brat
03:48:19 [PsychDr2B] lol
03:48:21 [hiwa] lactose tolerance test by H breath test
03:48:23 [Anil_Kumar980] ask the pt not to eat n look for reduced volume
03:48:27 [step1]»[PsychDr2B] rt....breath test for H2
03:48:41 [Anil_Kumar980] stool osm gap better but rarely done
03:48:41 [step1]»[hiwa] rt too
03:48:55 [Renegade] Courvoisier law states that..?
03:49:14 [Ahab] painless jaundice with gallbladder enlargement
03:49:18 [Ahab] not gallstones
03:49:22 [Ahab] pancreatic ca
03:49:34 [Anil_Kumar980] If the gall bladder is palbably enlarged it is usually not due to stones
03:49:55 [Anil_Kumar980] exceptions to this?
03:49:56 [Renegade] why won't gallstone cause bladder enlargement, then?
03:50:12 [Ahab] chronic gallstones fibrose bladder
03:50:21 [Anil_Kumar980] C/C cholecysatitis induces fibrosis
03:50:24 [Renegade] right
03:50:28 [step1] MCC of diarrhea in AIDS?
03:50:36 [hiwa] because it is already left a fibrotic GB behind
03:50:47 [PsychDr2B] CMV
03:50:58 [Anil_Kumar980] crypto n Isospora I guess
03:51:20 [step1] a protozoa: Cryptosporidium parvum
03:51:38 [hiwa] salmonella
03:51:51 [PsychDr2B] oh CMV for cholecystitis
03:51:56 [PsychDr2B] in AIDS
03:52:08 [Ahab] histological features of chronic cholecyctitis?
03:52:08 [PsychDr2B] right?
03:52:57 [step1]»[PsychDr2B] for food poisoning
03:53:04 [Anil_Kumar980] I thought CMV caused only Retinitis as MCC.IS it mcc for chole in AIDS as well
03:53:41 [step1] salmonella for food poisoning
03:54:29 [doctorjha] CMV is MC cause for retinitis and cryptosporidiosis for diarrhea in AIDS
03:54:34 [Anil_Kumar980] Isnt Campy MCC of food poisoning
03:54:43 [step1] CMV is common cause of diarrhea in AIDS....but MCC IS that protoz.
03:55:08 [PsychDr2B] ahh that clarifies it thank you
03:55:39 [doctorjha] Campylobacter is MC cause of gastroenteritis in US..
03:56:16 [Anil_Kumar980] okay
03:56:45 [step1]»[doctorjha] Norwalk is MCC of adult gastroen.
03:57:02 [Anil_Kumar980] person with hepatitis.His father was non smoker with emphysema.Abn in which organ is basis for pathagenesis
03:57:24 [Ahab] antitrypsin affects lungs and liver
03:57:30 [step1] Rotav. is MCC of childhood diarrhea
03:57:31 [Ahab] deficiency that is
03:58:09 [Anil_Kumar980] Yep and the basic abn is in liver.
03:58:15 [Anil_Kumar980] plant helps both
03:58:32 [Anil_Kumar980] liver transplant helps both
03:59:00 [step1] Gold standard screening test for malabsorption?
03:59:09 [Ahab] fecal fat?
03:59:26 [doctorjha] 24 hour stool fat..
03:59:33 [step1]»[Ahab] rt
03:59:48 [Ahab] Semi beh sci q here, pt suffers from ulcerative colitis takes up smoking. What do you say?
03:59:55 [Anil_Kumar980] 48-72 hr fecal fat
04:00:06 [step1] MC malabsorption in US?
04:00:10 [doctorjha] smoking helps it
04:00:29 [Ahab] but do you tell him to continue?
04:00:48 [Anil_Kumar980] no right
04:01:29 [Anil_Kumar980] Lactase deficiency-Is it the MCC
04:01:53 [Ahab] Risks of smoking outweigh the academic benefits
04:02:05 [step1] Celiac dis
04:02:40 [Ahab] anti-gliadin antibodies, villous atrophy malabsorption
04:02:54 [Ahab] highest incidence in ireland
04:02:58 [step1]»[Ahab] rt
04:03:34 [doctorjha] yeah, case is usually a white male from european descent
04:03:35 [hiwa] association?
04:03:53 [Ahab] maltoma?
04:03:59 [step1] Diff. bet. carcinoid tumor and carcinoid syndrome?
04:04:05 [Ahab] b cell lymphoma, sorry
04:04:26 [Anil_Kumar980] other Ig a s
04:04:31 [Anil_Kumar980] rm herp
04:04:36 [Ahab] carcinoid syndrome involves mets w clinical symptoms of hypertension, flushing, diarrhoea
04:04:43 [doctorjha] well, carcinoid tumor is MC in appendix bu carcinoid syndrome is MC in small intestine..
04:04:45 [step1]»[hiwa] HLA-DQ2 and HLA-DQ8
04:04:46 [Anil_Kumar980] derm herpetiformis
04:05:14 [Anil_Kumar980] is it hat hiwa
04:05:26 [Ahab] easy way to remember derm symptom, celiAc dis- IgA
04:05:33 [Ahab] derm herpetiforms
04:05:38 [hiwa] correct both lymphoma and derm herp
04:05:41 [step1]»[doctorjha] rt
04:05:57 [Ahab] tx?
04:06:35 [hiwa] remove gluten containing diet
04:06:43 [Anil_Kumar980] gluten free diet
04:06:49 [Ahab] correct
04:07:05 [step1] agree
04:07:05 [Ahab] derm lesion in IBD?
04:07:08 [PsychDr2B] Carcinoid tumors are all malignant
04:07:16 [Anil_Kumar980] pyo gang
04:07:24 [hiwa] eryth nodosum
04:07:27 [doctorjha] pyoderma gangrnosum
04:07:47 [PsychDr2B] pyoderma gangrenosum
04:07:54 [Ahab] erythema nodosum- sarcoid, TB, strep infection
04:07:59 [hiwa] pyoderma gang
04:08:14 [step1] serology in earliest phase of acute HBV?
04:08:20 [doctorjha] but, in spite of the name pyoderma gangrenosum has nothing to do with infection...its just an inflammation
04:08:51 [Ahab] good point jha
04:09:29 [PsychDr2B] HBsAg
04:09:45 [Anil_Kumar980] HBs Ag
04:10:03 [step1] rt..only HBsAg +
04:10:18 [step1] in recovery from HBV...?
04:11:02 [PsychDr2B] HBeAg
04:11:03 [Anil_Kumar980] Hbs ab IgG +ve,-ve for hbsag
04:11:37 [Anil_Kumar980] I think HBEAG reflecets infectivity
04:11:44 [PsychDr2B] I mean that HBeAg is decreasing
04:12:00 [step1] HBsAg - ,HBeAg - ,IgM AntiHBc - , IgG Anti-HBc + ,Anti HBs +
04:12:00 [doctorjha] Hbc AB also positive in recovery phase or previous infection
04:12:38 [hiwa] e antigen is the worst thing but e antibody is the best thing
04:12:47 [PsychDr2B] good question step1
04:13:04 [doctorjha] how u will differentiate the one with vaccination and one with previous infection?
04:13:48 [step1] Anti-HBs + with immunization
04:13:49 [hiwa] by IgG
04:13:55 [step1] against HBV
04:13:59 [Anil_Kumar980] Onlt HBsab+ve in people with vacc
04:14:26 [doctorjha] true...and HBc Ab wont be present in vaccination
04:14:34 [Ahab] BUN in liver disease, up or down?
04:14:43 [step1] and in recovered from HBV.....IgG Anti-HBc is also +
04:15:01 [Anil_Kumar980] Hey guys givin step one check out this site.Looks like its real good I just saw it
04:15:09 [Anil_Kumar980] http://umed.med.utah.edu/usmle/USMLE_EBOOK.pdf
04:16:00 [doctorjha] when r u takin step 2 anil and step 1 ppl when r u takin exam?
04:16:24 [Ahab] step 1 sept 11
04:16:31 [hiwa] No IgG in immunised only heps antibody
04:16:38 [Ahab] scored 560 in NBME 1 3 wks ago
04:16:59 [Anil_Kumar980] Hopefully in Oct and you doctor?
04:17:17 [Anil_Kumar980] wow Ahab I think thats cool
04:17:44 [doctorjha] well, i m taking the risk perhaps but its on 7th sept
04:17:45 [step1] scrotal pain and swelling,epididymal tenderness,Prehn's sign +....Dx?
04:17:46 [Ahab] did the whole thing in 50 mins, am really bad at rushing and not reading questions
04:18:00 [step1]»[Ahab] really cool
04:18:05 [Ahab] missed about 10 qs because of it
04:18:13 [doctorjha] my CS is in 5th october..so, need to hurry a bit
04:18:33 [Anil_Kumar980] guess thats the single mst imp thing in the exam.Slowly readin the ques
04:18:45 [Ahab] hopefully will score above 230, am hoping for at EM in Washington U
04:18:52 [Anil_Kumar980] but do not miss any ques
04:19:24 [Ahab] some good scores coming out of our forums
04:19:31 [Ahab] great to see
04:20:00 [hiwa] thanx anil was great site
04:20:33 [doctorjha] I m among the low-scorers...:-) got 80 in step 1, hopin to improve in step 2
04:21:04 [step1] hey guys .you want to continue chat....bec. it is more than 3 hrs now.....i am tired so,if u want to continue.carry on..i will post the transcript
04:21:06 [hiwa] thanx guys goon nite
04:21:24 [Anil_Kumar980] thank you step1 Nice chattin
04:21:29 [Ahab] think i will head to bed now aswell, thanks for hosting step1
04:21:34 [step1]»[hiwa] good night hiwa...thanks for coming
04:21:49 [step1]»[Ahab] u r welcome
04:22:01 [Renegade] Kumar, gotta complete that link of yours
04:22:09 [Ahab] later guys
04:22:20 [PsychDr2B] my computer keep sfreezing anyway
04:22:26 [Renegade] Ixodes bug transmits more that babesia and Lyme's
04:22:27 [PsychDr2B] Please rest and see you next chat
04:22:34 [Anil_Kumar980] I did
04:22:36 PsychDr2B exits from this room
04:22:44 [Anil_Kumar980] http://umed.med.utah.edu/usmle/USMLE_EBOOK.pdf
04:22:52 [Renegade] Too bad I won't make it for micro tomorrow. C ya....
04:22:55 Ahab exits from this room
04:22:59 [step1] good night everybody.....and thanks a lot
04:23:18 sujju enters this room
04:23:23 [doctorjha] thanks a bunch step 1
04:24:13 [step1]»[doctorjha] thanks to u too....nice chat
04:24:36 [step1] hope to see you again ..good night
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